The journey to market access 5.0

Pricing and reimbursement challenges in most western markets have evolved over the last 15 years with a corresponding evolution in the market access response from the pharmaceutical industry. However, securing product access and commercial success in Western European healthcare markets is becoming increasingly more difficult: 2012–15 will be a defining period for the long-term success of the industry, according to commentators, including PriceWaterhouseCoopers and Dr Brian D Smith.

Demands on healthcare budgets are growing as are demands on healthcare systems to provide appropriate treatment and care. In this context, payers across Western Europe are demanding not only that companies demonstrate that the products add more than incremental value to patients but also offer a package of supporting services that can secure patient outcomes (see Market Access 5.0 opposite).

If there is consensus on the hypothesis that pharma needs to demonstrate that its products add value to patients, how does pharma re-engineer itself to be able to provide integrated product solutions?

The pharma industry is at different stages in terms of response to this challenge. Sir Andrew Witty of GlaxoSmithKline (GSK) articulated a sales strategy that is based on shifting away from 'white pills in western markets'. If pharma is not selling 'white pills' then what should be its focus? Where has it been and just where does it need to get to by 2020?

Modelling the market access 5.0 roadmap

1.    Continued expansion of payer insight into integrated strategic plans from an early stage

• Brand planning processes that integrate strategic payer insight into shaping the design and scope of clinical studies
• Payer value dossiers reflective of the 'real' care paradigm
• Value propositions aligned to healthcare agendas and priorities
• Development of planning processes that enable individual market variables to be taken into account
• Co-create solutions with national, regional and local payers
• Bridge the 'trust' issue with payers and demonstrate a capability to work in a partnership engagement model with local and regional payers. Perhaps the industry should consider a quality standard accreditation?
• Entering into strategic partnerships with local/regional payers requires a commitment to three-year service delivery agreements. How can pharma take a longer-term approach to RoI?

2.    Greater understanding of care pathways and decision making around the position of the medicine – patient profile, stage of disease

• Develop consistency on the care pathway approach
• From data rich to insight rich: extract meaningful data from internal and external systems to effectively transform the way brands/services are positioned and patient benefits are delivered
• Reaching consensus on the scientific value of real-world data
• Processes to allow for innovation to develop clinically meaningful measures
• Customer marketing approach detailing the value package and not just the brand.

3.    Continued up-skilling of organisation and customer-facing employees to develop strategy and bridge implementation successfully in an environment of increasing complexity at a local/regional level

• Accelerate the evolving  mindset of pharma leaders to embrace fully market access 5.0
• Review marketing expenditure to ensure the right proportions are being spent in the right areas. For example, disproportionate spend on payer and patient insights in the market research budget
• Extend/develop a customer-centric culture to include payers and patients
• Managing internal change to align what is meant by value, value proposition and value assurance. Having processes in place to achieve this systematically
• Redesign competency frameworks and commit to on-going knowledge and skills training
• Performance management: smarter metrics as measures of success
• Innovative incentive schemes that reward the 'right' behaviours.

4.    Improving RoI per patient – focus on patient outcomes and increasing patient adherence

• With value-based pricing requiring a clear and convincing communication of the benefits of a medicine at launch and beyond, pharma needs to ensure that the benefits seen in clinical trials are also seen in a real-world setting
• Pharma needs to support a more holistic approach to improving patient outcomes
• Patient engagement: with approximately 70 per cent (BUPA Health Pulse 2010) of people using the internet to access information on medicines, how does pharma make sure it gets accurate information and the support it needs?  
• Patient engagement: with >10 per cent of people in the UK posting comments and questions online, how will pharma take part in the debate?
• In 2008 it was estimated that approximately 15 per cent of marketing budget was spent on patient communications (Cutting Edge Information, 2012). Does that truly reflect a patient-centric approach?
• As individuals are able to access their own data the doctor–patient relationship will change to become more of a partnership. How does pharma further evolve from a prescriber-centric approach?

5.    Collaboration and strategic alliances with other companies – pharma and non-pharma – to improve outcomes

• Allocate budget and resources to this type of business development
• Partnerships to design improved patient services
• Incorporate relevant telehealth and other technology led opportunities
• Develop clinical trials models to assess the full service package.

If these points serve as a checklist for the commercial platform in Western Europe, how ready are you for Market Access 5.0?

There is increasing agreement that the old pharma commercial model is no longer fit for purpose. The sales and marketing model is being forced to move to one that is much more complex in a Europe-wide environment of change with incredible pressure to reduce budgets. Successful companies will be the ones that focus their organisations on delivering real, demonstrable value to the patients they serve in collaboration with payers.

Market Access 1.0 Collation of all payer activity under one umbrella approach Formation of specific market access (MA) teams A view that this is a temporary barrier to commercial success.

Market Access 2.0 Increased variation at a local level, development of local/regional teams MA still viewed as separate entity from traditional sales and marketing approaches.

Market Access 3.0 Integration of MA into sales and marketing models MA increasingly driving commercial strategy Recognition MA here to stay Ad hoc market research with payers.

Market Access 4.0 MA defining commercial strategy Impact on sales no longer questioned Market access excellence seen as critical to brand success over entire life cycle MA organisation capability programmes in place Payer insight, mapping and segmentation Embryonic discussions about preventative health.

Market Access 5.0 Greater patient centricity The networked pharma company Innovate, pilot and up-scale Increased focus on patient adherence Managing the dichotomy of delivering a coherent and aligned strategy in an increasingly complex market where regional service innovation and diversity are significant Identification and focus on different stages of a disease and the best responders Increased investment in innovations that improve outcomes Fully integrated clinical and preventive care pathway Well developed data and intelligence on population health outcomes locally and nationally.

The Authors